Exploring better ways to start dialysis. Show, Train, Reassure, Educate and Assess Month [STREAM-HD]

Prof John Agar1, RN Rosemary Simmonds1, RN Richard Knight1, A/Prof Christine Somerville1

1Renal Services, University Hospital Geelong, Barwon Health, , Australia

Introduction: The induction of new patients into haemodialysis (HD) programs is often poorly managed. Despite routine pre-dialysis education programs, incomplete engagement and/or frank denial of approaching HD dependence leaves many ill-prepared as they defer their decision till their pre-dialysis clock strikes midnight. Further, despite pre-dialysis attempts to identify potential ‘home’ from ‘facility’ suited patients, many patients and families still struggle to appreciate option nuances before their actual dialysis begins. We describe a Show, Train, Reassure, Educate, and Assess Month [STREAM-HD] that we think may add value to the pre-dialysis education paradigm, and help to increase home HD uptake.

Methods and Results: All patients new to HD spend up to their first month of dialysis in a 4-6 chair education and assessment (E&A) ‘pod’ sited within an existing but purpose-expanded home training unit (HTU). Exposed to skilled HTU staff, intensive but empathetic, one-on-one E&A during dialysis permits both staff and patient to understand/assess all options and potentials. Placing the STREAM process within the HTU environment crucially allows: (1) HTU staff to identify and home-enthuse patients suitable for home HD who may otherwise slide, uncaptured for home, into facility care; (2) undifferentiated new patients the opportunity to witness and learn from the ‘can-do’ attitudes of other home trainees, or from established home patients, first hand.

Conclusion: While too early to judge our SRTEAM-HD outcomes, feedback is strongly positive. We believe the STREAM-HD approach may offer a new and better way to identify home-possible patients and to grow the home haemodialysis pool.


Conjoint Clinical Professor of Medicine and Consultant Nephrologist, University Hospital Geelong, Geelong, Victoria, Australia. Interests: home nocturnal HD program in Australia (2001, Geelong); exploring concepts and practices in more environmentally sustainable dialysis and nephrology; Published >230 peer reviewed papers and abstracts. Awarded OAM for Services to Renal Medicine (2009); ANZSN Life Membership (2011), RACP Life Membership (2015), Priscilla Kincaid Smith Medal for Outstanding Contribution to Australian Nephrology (2015), and the ISHD Zbylut Twardowski Lifetime Achievement Award in Hemodialysis at the Annual Dialysis Meeting, Long Beach, California (2017).

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